Monthly Archive: March 2012

My search for a counselling model has been long and circuitous: there were many models and theories that did not resonate with me, but finding a friendly fit was difficult. I liked what Rogers, and Maslow had to say, but this did not feel like the whole story to counselling.

I learned more about being a good counsellor after school than in school. In my practice, I have always been seen as an enigma, because for most counsellors theory or tools of a theory was more important than the client and relationship. In spite of not focusing on theory I was usually seen as effective. The feedback I received from clients and other therapists who saw clients I had seen was that I was the most non-judgmental person they had met, and so they felt free to tell me anything. Much literature in the field of counselling reports relationships as being more important than any theory. This concept I embraced fully.

When I started teaching counselling, I became acutely aware of my personal style of counselling. Later, I was given the task to train peer counsellors, an opportunity that helped me articulate principles that informed my own counselling approach. It was especially important that I understand my own counselling approach to clearly develop an effective approach to peer counselling. I felt that a clear simple approach was necessary, as I did not want to inundate peers with theories, and rules about minutiae, such as how to sit or how to move; I have always felt that if you are really empathic, you will naturally convey that interest and concern.

I eventually developed a simple approach to peer counselling that could be fully explained in just 15 words. The concepts are simple, but counselling using this model is difficult to carry off at first.

No judgment

Acceptance

No fixing/no advice

No questions

It is not about you

Empathy

(You may notice the first letters spell out NANNIE)

I believe that the above model is just a 21 century operationalization of Rogers’ concepts of client-centred therapy. Rogers spoke of a “person centred” approach to counselling. These six simple concepts are merely an operationalization of a person centred approach. The client is in control of the content and direction of the counselling. This approach is designed to give the client all the power. Counselling sessions are the client’s time and space to explore/process/think out loud I believe this approach emphasizes the importance of building an empowering and accepting relationship with the client which is one of the goals of good counselling.

For counsellors, these six concepts are simple, but deceptively challenging to apply. Despite our training, too often our own needs get in the way of helping a client. When we tell clients how they should live their life, it is too often ultimately done more for ourselves: to make us feel good, helpful, and that we are “providing a service”. I believe that what we as counsellors give to our clients are safety, security, and freedom to be, and freedom to explore. By creating a safe space to explore ideas and feelings the client can express himself more deeply and explore feelings and emotions that he may otherwise hide from.

No judgment

No judgment is about not having a personal reaction so someone else’s actions. Such reactions might be, “Oh good, you stopped drinking”, or “It is too bad they could not stop drinking”. We are often unaware of our judgments of others. We see praise not as judgment, but of course if you think about it, praise is judgment. We are not there as a counsellor to provide a cheering section for what we think is appropriate behaviour. It is not about you and your judgment, as a counsellor, of what is good and what is bad for a person. Sometimes, more often around abuse of someone else by a client we find it hard not to judge our client. It is important at these times to remember that we are all trying to get through this life the best way we know how. Our clients come to see us because they are having trouble, they do not need our judgment (criticism) to help them grow. They need our support and acceptance, not our praise or criticism.

Acceptance

The difference between acceptance and no judgment is sometimes difficult for counsellors to understand. Acceptance is more about not trying to change someone, taking them as they are; it is not having a “therapeutic plan” for them to change. Most frequently it is a plan to help them stop drinking, stop them doing drugs, a plan for ridding them of depression etc. Acceptance is accepting a person as they are without expectations of them changing, growing, or becoming something else.

No fixing/no advice

The question often comes up about giving advice. If you the counsellor have important information that the client needs then providing the facts without directing an action is respectful and helpful. If a client says “My driver’s license expired, Is it important that I renew it?” The counsellor could talk about the process of renewing and the consequences of not renewing, all without directing the client to take a specific action.

No questions

Most counsellors feel lost without being able to ask questions. Just the act of asking a question puts the counsellor in control by demanding answers to the counsellor’s needs and not the client’s needs. The counsellor tells himself that he is doing it for the client but it is detracting from the client being in control, questioning may get in the way of having a safe and free space to explore. Asking questions is more about the counsellor’s needs and curiosity/voyeurism and less about the client’s need to tell his story. Much of what counsellors do, they do to keep themselves in control and look knowledgeable and helpful.

I once worked with a guy for about 4-6 months and he kept referring to “the accident”. He never talked about what this accident was or how it happened, but about almost dying, his families reaction, and him feeling scared because of surgery. I was very curious about what the accident: What was it that he did? Did he cause it? Did he hurt others? All of these questions. But that was all about me, and this is his story, so I never asked. One time when he was going into more discussion about the accident, I commented that it seemed like he still had unresolved issues about this accident. After a long pause he really opened up about how he felt, his fear of dying, being crippled, his family reaction, his feelings of guilt or stupidity in the accident. He could see how he had just compartmentalized the experience, but never dealt with his feelings about what happened. By not asking for a recitation of what happened but offering an opportunity to explore feelings about what happened he could begin to address unresolved issues.

It is not about you

Counsellors often violate the “It is not about you” rule. For too many of us, counselling is too much about us, our attitudes, our knowledge, our expertise etc. How often has it happened that clients have told us they went to a different counsellor and that other counsellor kept talking about themselves? Though this may not be what actually happened, it was how the client experienced the counselling. Letting go of our ego is not easy.

I am often taken aback at the end of counselling relationship with someone they tell me how helpful it was and how much they got out it, and how much I did for them. I always think “you did all the work, you made your choices, you took the risks, you made changes in how you behave, I just was here, but “you did the work”! The counsellor cannot begin with a plan of: “This is how you need to change …”. That is not respectful, it is not accepting, it is not empathic, and it is often more about the counsellor than the client. We should not be developing a plan for someone else’s life. It is a big megalomaniacal to think at our role as counsellors is to develop a life plan for anyone.

Empathy

Empathy is not always easy. To often we put our own spin on our client’s experience. I remember a client who was gay telling me that when he was 12, his mother told him that she was lesbian. My empathic response was, “So you felt like she would understand your attraction to boys.” He told me, “Oh no, I made her promise that she would never date a woman and not be a lesbian.” He then added that he knew if his mother could not fight these feelings, then he was doomed to be gay all his life. He was not ready to face that at age 12. Well I really got it wrong, but he told me so much more about himself and his development by correcting my misunderstanding I was much more able to empathically understand him by being wrong and sharing my mistaken understand of his experience. If I would have not said noththing, and just “know” the truth of my perception I would have not understood him and his journey to adulthood. I have found that it is often very helpful when I make mistakes and am not really empathically in tune with my client. Much too often counsellors are afraid to be “wrong” in their understandings of their clients. I have never had a client be offended by my not getting it, but they only work harder to help me understand their feelings.

Empathy and understanding is not enough. When teaching these counselling techniques, I give an example to show clients sometimes need more than empathy and understanding. I give the example of the most empathic, understanding counsellor response to the person who asks where the WC is. Such a counsellor may empathically understand the need to find the WC, and empathically reflect the frustration and not getting any answer to the question, and accurately reflect the urgency and discomfort the client is feeling. But the empathy is not what the “client” needs; factual information is what is needed here. To often we tell ourselves that we “know” things that we must impart to our clients, often that is for our ego not for the client’s growth. One has to be very careful when giving information, that we are only giving factual information without directing an action.

This approach to counselling means having no personal or ego investment in your client and his future, but making a professional space that supports your client. We as counsellors are most helpful when we let our clients grow in their direction and not try to force our beliefs of how they should live their life. This is very hard for most counsellors. The only place we as counsellors know about having influence over others is when parenting, and we are most likely trying to hard to control our kids. One of the biggest challenges in parenting is letting children make their own mistakes. Counsellors also face this challenge in letting clients make their own decisions and go in their own direction: as counsellors, we often fear the consequences.

In our own childhood, we, like most others, were likely not allowed to grow in our own direction. Maybe we as counsellors have never experienced the kind of acceptance, trust and non-judgmental space presented in this counselling model. It can be hard to learn how to be accepting and non-judgmental when we may have never experienced it ourselves.

When I was a psychologist in a federal prison in Canada, I felt like my job was to help these guys find their path in life, which may not always be staying out of prison. Many times guys said my office was the only place they could really talk and explore their feelings, fears, and fantasies. They were generally guys who never experienced much acceptance and understanding. When working with drug users, my job is not to help them get off drugs but to help them to understand their lives with drug use and support them in planning the future they choose/makes for themselves. I am not afraid when they use drugs again; generally we look at it together as a learning experience for them to understand more about themselves. I feel that often drugs are not the problem but the symptom of someone who cannot find a way to live that works better for them. I assume the drug users who are happy with their situation do not seek out counselling.

I think our counselling methods are an expression of our beliefs and feelings about ourselves. It seems like often the best counselling approach is one what resonates with us. I think more of variability in the effectiveness of a counselling approach comes from our ability to embrace the theoretical principles, but not in how effective a counselling approach/theory may be. If a theory of counselling feels foreign to us, then likely we will not be very effective in using it once we learn the basic skills of that theory. If you lean toward a client-centred approach, then some of these methods may be useful in developing your approach to counselling.

IT may be time to explore the systematic causes for the reasons that gay men’s health is being generally ignored by governments. Before our health needs will be addressed appropriately we need a strong lobbing or advisory group who is not government funded and it free to take a strong stand on important issues.

An example of poor government action on gay men’s health is PEP. PEP will effectively halt HIV infection in persons who have had a risk the previous day (or two). PEP has been made available by many governments around the world. Even in what some may think of as a slow and backward country like South Africa has made PEP available for years. But, not in BC. Why are we so slow? Why have gay men become infected by HIV for years when they did not need to be? I believe that it is because we have not had a strong independent voice to harass the government and force change. HIM over a year and a half ago wrote a paper on the benefits of PEP and quietly lobbied the government. An influential gay physician wrote a strongly worded letter to the government body responsible for PEP, pushing for PEP. Yet still we have only a local trial of the use of PEP that begins this month. If you do not live in Vancouver you are out of luck.

A local gay agency has had some of its funding withheld because this Conservative government did not approve of their actions. We cannot count on our non-profit agencies to take strong stands against government. If they do embarrass governments then we risk them losing funding, and us losing these effective agencies in our community.

In the early 80s the agency which preceded Positive Living (PWA) was loud and unrelenting in forcing proper care and treatment for persons with HIV. Guys were literally fighting for their lives, and it is because of this that they were able to force governments to address the needs of those with HIV. We now have no group who can forcefully stand up to the government to demand proper policies and services for gay men.

When profit is part of the equation then policy advancement slows dramatically. It took almost 20 years of research to “prove” that cigarettes cause cancer. Everyone admitted that there was a link of cigarettes and cancer but no real proof of the cause for over 20 years. In our case we have a study that was done that saw that people who used water based lube for anal sex were three times more likely to get HIV or STIs. Upon exploring this relationship more it was found that likely most water based lube damages anal lining. Now we are two years after the original research but no authority will advise you to consider not using water based lube, until it is further understood. Though there may not be “proof” of water base lube causing HIV and STI transmission you should know there is an apparent link and you can choose lube according. Who is advocating for us?

Another example of poor government policy came to light when I was writing about condoms provided to our community. I was told that the Ministry of Health formulates it policy for the entire province. They would not tell me what criteria was used to select “proper” condoms, or who was on the committee that is charged with this task. If 10% of the population is gay, then 5% of the provincial population are gay men yet they account for over 50% of the HIV! It seems only sensible that the most useable and effective condoms be made available to gay men. No changes will come about until the government is forced to take action.

I am calling for the Provincial government to formulate a committee of gay men who are not part of the government or government agencies who are not afraid to ask difficult questions and push for effective public policies for our community. Current policy that is formulated seems to come from persons who read about gay men and their sexual behaviour, but I wonder if any of them making policy affecting gay men really understands the complex dynamics that are part of our sexual community. It seems only reasonable to ask “the experts” – in this case the experts are not those who read about gay men’s sex but those who know and understand the complexity of gay sex.

This is my last regular column in Xtra, but you can follow some of my thoughts on my blog – bcoleman.ca where you can find writing that did not make it into print and other random thoughts.

This one tends to continuation on from my last article in Xtra on 15 Dec 2011, but from a new angle.

I recently talked to an MD who works for the government in the field of HIV and s/he said that we need a nuanced message to deal with the new information out there about undetectable viral load reduces the risk of transmitting HIV. S/he feels we need new messaging because s/he see people every day coping with viral load questions. My response was that the CDC does not know the meaning of nuance they only know short messages with an all or nothing message, Later I talked with one of those bureaucrats that is part of developing those all or nothing messages. (S/he does not see patients in real life, and I wonder if s/he only knows about sex from journals and books.) S/he confirmed s/he likes the all or nothing short simple messages. Short and simple seems to be more important than how accurate the message is.

What if you wanted to go skiing and wanted to make sure you would not get injured in an accident on the dangerous highway 99. You could decide to drive only between 2AM and 3AM, when there are fewer cars, you can get the best snow/ice tired there are, you can get the safest car with the most air bags, you could decide to only drive on days when there is no snow or rain. But likely this would not be practical or fun – but safer. Likely you will just drive to the ski hill when you want to ski and tell yourself to be careful. After all you did it for two years and had no problems so just tell yourself to be careful. Well it is a lot like fucking. There are things you can do to make it safer but they may not all be fun or practical.

The Journal Science has declared that the scientific breakthrough of 2011 was a study (HPTN 052), this study found that a person with an undetectable viral load reduces transmission of HIV by 96%. One article said “Having an undetectable viral was as effective as condoms.

That is like going to buy a pair of jeans for $100.00 but finding out they are reduced by 96% so they now cost $4.00. That is a huge difference.

So lets look and what this means for fucking without condoms. If you are getting fucked raw by a HIV poz guy with and undetectable viral load the chance of getting infected goes from 1 in 200 (no HIV treatment) to 1 in 5,000. If you are fucking a poz guy raw with undetectable viral load the chances of getting HIV goes from 1 in 1,538 (no treatment) to 1 in 38,461.

So if you have sex with a poz guy with an undetectable viral load and if you use a condom that reduces it a further 96%. So it is like those $100 pair of jeans go to $4.00, and then are deduced again by 96% and now they cost 16 cents.

We are told that BC government is spending $50,000,000 to get as many positive persons as possible to have an undetectable viral load. They call it “Treatment as Prevention”, but that is just the marketing to the government. It is not preventing HIV transmission but it is reducing the risk of getting HIV by 96%.

The risk of fucking without condoms changes dramatically – yea it is reduced by 96%!. What do us as gay guys do? Do we take more risks? Do we decide that maybe we play more in the sandbox with the poz guys with undetectable viral load because they are not so scary now?

Do negative guys become scarier to play with because 2.5% of them may be poz and not know it and therefore may be 20 -25 time more likely to pass on HIV. For the guys who think they are negative but are newly positive then getting fucked by them changes the risk from 1 in 200 for a (poz guy with detectable viral load) to 1 in 10 for newly poz guy.

You may ask a negative partner if he get tested on a regular basis. If he does it likely is because he is concerned he is maybe positive. So why would you think he is negative if he thinks he may be poz and gets tested regularly to find out.

So if you decide to have sex only with guys who believe they are negative what is the chance of getting HIV? We know 2.5% of those guys who think they are negative are really positive. If we assume that those 2.5% are newly infected and that is why they do not know they are poz then the chance of becoming poz is about 1 in 200 if you choose only guys who think they are negative. An interesting number – it is the same number as getting fucked by a poz guy with detectable viral load.

Where do all these numbers leave us. Well poz guys with undetectable viral load are a lot less likely to infect someone then if they did not have an undetectable viral load. Negative guys who will take risks with you will take risks with others also, – did you think you were special – so he may be poz.

A number of negative guys have told me that often poz guys are just more fun to have sex with than negative guys.

So where does the leave us? Are poz guys (with undetectable viral load) sought after now, and are the “negative” guys shunned as having the potential for infecting others? The science may say there is a good case for this. But after all it is fear and prejudges that made many negative guys shun poz guys in the first place, – it was not science! Our prejudges against poz guys as sex partners will not change easily.

What we do not need is the institutional marginalization of poz guys. Many organizations will tell us we are at higher risk if we have sex with a poz guy. Surveys ask “do you have sex with poz guys?”, they then tell you are at more risk if you do have sex with poz guys, this is not true if the viral load is undetectable. The institutional response should be: “ know your partners viral load” not his HIV status!

Well this is my last regular column in Xtra, I plan on doing a retrospective piece next month outlining what I have learned while writing these pieces and bring up a few points to consider. I may be back with the occasional writing on gay men’s health.

For years I have been at meetings where discussion of sexual health messaging, policy and procedures is taking place. Too often these meetings are dominated by women. Few men and often I am one of the only or few gay guys there. Of course many meetings happen that I am not part of but it seems like most of these meetings are dominated by women.

I was told by a gay guy that he attended a half day meeting about spending the $50 million dollars for BC HIV “prevention” (this is another story for next time, 50 million for what?), he said the presenters never mentioned the words gay, MSM, homosexual. But there was discussion on mother to child transmission, which has happens much less than one time a year. I must add that the women try hard to understand gay men’s issues. Not long ago I was at a meeting (the only gay guy in the room), it was about gay men’s sexual health issues. There was discussion about a new term “pig sex”, and this was being explained to all assembled. It feels strange to be sitting with a bunch of straight females talking about gay guys having “pig sex” (as a new phenomenon). Where are the gay men in these discussions? If gay men are not part of the discussions then who will try to understand our needs, someone has to. It is not easy for someone outside the community to fully understand, it is hard work for these people, they need our help.

An example of this kind of ineffective practice is a situation where men would be telling women about what being pregnant is like. They can talk about it and have an understanding of the concept of pregnancy but they can never know pregnancy the way a women can. The women often involved in gay health research, know their limitations, want to understand and want to help gay guys live a healthy life. I have always felt welcomed and my comments as a gay guy are always greatly appreciated, but ultimately most policy and procedural decisions about treating gay guys are made not by gay guys but by straight women and straight men.

HIV education needs to acknowledge as a basic truth that sex for gay men isn’t just a collection of physical practices to be modified. It’s how we relate, how we connect, and yes, love. Understanding that is where HIV education needs to start. I modified this quote from:

Gay guys are the largest group of new infections of HIV, by far! Gay guys are the largest group of group of new syphilis cases by far. If gay guys are such a large group of the sexual health clients then where are they in being included in part of the solution. It seems like HIM (Health Initiative for Men), and PWA are well placed to have or develop their expertise in sexual health of gay men, and should be a permanent consultant to all discussions about policies and procedures relating to gay men. I do not think they are asked for their input and understandings very often. Gay men should be a main part of all training of sexual health nurses, because they are the main part of the positive syphilis

Many HIV organizations will tell people to “know the HIV status of your sex partners”, I think this is bad advice. There is now at study that shows it is bad advice.

It seems that anyone who tells you to know the status of your sex partner is setting you up for risk for becoming HIV+. The first question is why do you want to know the HIV status of your sex partner? If you are fucking with condoms, then their HIV status does not matter. If you are not fucking then HIV status will not matter.

When you compare the amount of HIV virus a person has, the guy on effective treatment likely has an undetectable load, (meaning <40), the guy who is most likely to have 200,000 time more HIV virus in them is the guy who thinks he is negative, not the poz guy. He may have 200,000 times more virus than the poz guy on treatment for 4-26 weeks. This makes the guy who thinks he is negative much more likely to pass on HIV.

Well lots of us guys fuck without condoms at times. We know this happens, a lot. By playing with the stats, we are trying to find ways to make fucking without condoms ok. Well it is not easy to do. Monogamy is one possibility, but I have talked to too many guys who say “my boyfriend thinks we are in a monogamous relationship.” Only fucking with negative guys is another but we cannot know if they are truly negative.

Why would anyone tell you to know the HIV status of your partner, it seems beyond reason to me. A person can only know their HIV status if they are HIV+, or not having anal sex and had a negative test. Someone you meet for sex will almost for sure not be able to know they are negative. They can say they had a negative test last month, last week or yesterday, but that does not mean they are truly HIV negative. (Positive results do not show for 10 – 90 days depending on the test.)

Talking about HIV status as a screening device to decide who you will have sex with goes a long way to marginalize and stigmatize HIV+ guys. Do we really want to isolate and discriminate against 20-25% of our own population? A study in the last year, explored anal sex contacts of 2623 gay guyswho do not always use condoms. The results showed that serosorting , that is: assuming, knowing, or being by a sex partner that they are HIV- -only gave a person a “small decrease in risk of getting HIV”.

How do we make the decision to fuck without condoms? We know it is a risk to become HIV+. So, some of us will drink too much to really think about it. Some of us will do other drugs to “not care” at the time they are fucking. Some will tell themselves he is so nice, so hot, in such good shape he cannot be HIV+. I often think if someone wants to fuck with me without a condom, do I think I am special and the only one he does this with? If there are other guys he fucks with then there is a bigger chance he may be positive without knowing it. Some guys will ask if he is negative and then feel the chance is lower.

So we have a widely accepted practice of telling guys to “know the status of their partners, we now know this is bad advice. This advice will further divide our community into HIV+ and HIV- guys. We need to support each other, have sex together, and accept our differences.

I have spent over 20 years talking to gay guys about their lives, their sex and HIV. Having shared the pain of HIV with hundreds of guys, I think I am extremely sensitive to the agony that HIV can cause. I will do what I can to help our community to grow strong and be healthy. Hence the motivation for my writing a health column in Xtra. I hope to never attack anyone in our community or any community organization in this effort, however I will criticize the government (and others) and their policies when they are harmful to our community.

I was surprised that there was controversy about my column on condoms. My intent was to question the quality of condoms the government is providing. I had expected that both BCCDC and maybe other organizations would come out with statements to the effect that they wanted the best possible condoms for our community and that they would research condom failure rates in an effort to help keep our community safe and healthy. I researched the facts before I wrote the column, and did more research after it was published. I stand by what I said in the column in Xtra. US FDA began to use the same international standards as Canada in 2009, their standards before 2009 were very similar to the international standards Canada uses. In both countries condoms are medical devices. I am hoping that the column on condoms will result in the best possible condoms for our community. It is too bad that we have not seen progress on this issue so far.

Who thought condoms could be so exciting? Here I am again talking about condoms. I thought that there would not be so much to say about these little guys but I guess there is. There are a few points to talk a bit more about.

First of all just about everything you buy inCanadahas some kind of standards that it must pass. I could not think of anything that didn’t. At first I thought maybe if you buy dirt for your flower patch it would not be controlled, but no almost everything has to pass standards, this includes condoms.

Condoms in Canada must adhere to International Standards. US also in 2009 began using the same international standards for condoms, before 2009 they only used a US standard that was almost the same as International Standards. So if you go to theUSand get condoms they too should be equally safe as you good old Canadian condoms that you are used to.

I asked Jody Jollymore at HIM about their condom distribution program. Though they have not done a formal survey of their condom users they hear good things about them. Jody feels that the current condoms are better than the old ones that they used to provide, in that he gets reports that they are thinner and feel better.

All condoms brands will have a few that break in use as Consumer Reports says some brands will break more than others. Studies of heterosexuals show about 1% of condoms break. But maybe (it is only a guess) gay guys with more practice and experience have a lower percentage of breakage. But it is interesting that if HIM gives out 150,000 condoms in a year, 1% breakage would mean 1,500 would break, if we are better at using condom than most and have half the breakage rate then 750 of these condoms would break. But no one, not one person, reports condom breakage to HIM. Elgin Lim of Positive Living also told me that they do not get reports of condoms breaking. I personally in social discussion do not hear of condoms breaking, but as a therapist I do hear of them breaking and it affects peoples relationships, and sense of safety and security in having sex. But it seems people do not talk much about condom breakage socially.

Now for some good news. Jody told me that HIM will respond to requests for larger condoms and non latex condoms by providing these condoms at the Sexual Health Centre beginning next month (he hopes). (address and opening times here???)

Non latex condoms are important for guys who have allergies to latex. Many guys may not know that they have a latex allergy. I am told that a non scientific test to explore if maybe you have a latex allergy is if you blow up a balloon or two or three and your lips tingle and feel a little numb you may have a latex allergy. This maybe something you want to explore further because you do not want your cock or your asshole to feel numb, feeling is part of the fun of fucking.

I talked to Elgin Lim at Positive Living Centre about their condom distribution program and he said they get their condoms from Vancouver Coastal Health, he said that they receive comments on their condoms that they are a bit “basic”, guys say they do not fit well or feel good to use. They are trying to obtain different condoms for their members.

I asked BCCDC how they choose their condoms and at press time they could not provide an answer. So there seems to be no more information I can find as to how BCCDC chooses their condoms and how they rate in terms of failure rate to other brands.

Some people are immune to HIV (well, almost totally immune). There are thousands of organizations giving public messages about HIV, but very few will talk about genetic immunity to HIV. The general understanding of immunity to HIV is that some 1% to 3 % of the population is immune to HIV because of the genes they carry. People fromSwedenorNorthern Europeseem to be more likely to have this genetic immunity.

However, there are a few people who have become HIV+ even though they were supposed to be immune. This is an extremely small number, but the immunity is not 100%. When I talk about immunity in this article, I, am therefore referring to almost total immunity.

I first heard about HIV immunity back in the mid/late 90s. At that time, a gay guy who I knew socially told me he was a researcher who was doing research into genetic immunity to HIV. He told me that he felt that the only way someone who had the CCR5 gene (the name of the gene linked to immunity) from both parents was for them to have the virus in the anus from someone who had fairly advanced stage of HIV. I have lost track of this guy, but the last I heard he was still working on this research in theUSon the East Coast.

To be immune to HIV both of your parents must have the CCR5 gene. IF only one of your parents have this gene, then you will be less likely to become HIV+, and if you do become HIV+ then you are more likely to be a non-progresser, which means that HIV will not have as severe effect on your body. About 10%-15% of the population fall in this group of being less likely to become infected. One study from 2001 in Science Daily reported that persons with the CCR5 gene from one parent “had a 70% reduced risk of HIV infection”. I have talked to lots of guys who say: “I have had lots of unsafe sex and I am still negative so I must be immune”. Well it may be, or it may also be that instead of 50 time of unsafe sex it may take 400 times before this person becomes infected.

I found a story by the Australian Federation of AIDS Organisations Inc. (2007) describing an Australian company, delta32.com.au, who advertised on Gaydar.com.au to offer CCR5 gene testing. Two organizations complained that the company should not test gay guys for the CCR5 gene, and the website was soon closed. Many other websites I found were closed down, or did not reply to my emails. There appears to have been pressure to make sure people (gay men) are not allowed or encouraged to find out if they are immune from getting HIV.

Despite this, it is possible to get tested for the gene that causes HIV immunity (CCR5). But before we go there, there are a few important questions to consider. These questions are: Would you want to know if you were immune to HIV? What would you do with that knowledge? Would you stop using condoms? Would you believe someone who told you they were immune to HIV so they do not have to use a condom to fuck you? What about STIs? How much would it be worth for you to find out if you were immune to HIV? These are all interesting and difficult questions to sort through. But the real question, I believe is: should you have the right to know that you might be immune to HIV? Is it better that we do not know that HIV immunity exists? Does this make a better and safer society? I have no clear answers to these thought provoking questions. But I tend to believe that honesty and transparency makes for a better society. I do not think there are many times that hiding information from the public is a good idea.

So, I did a great deal of searching online to find someplace you might find out if you had the CCR5 gene and if from one parent (partial immunity) or both parents (almost complete immunity).

IF you are an HIV+ guy, would you want to know if you had one of the genes meaning that you are less likely to have complications from HIV? I am sure there are some people that think that people should not be allowed to know if they have the CCR5 gene. But if you are not one of those and are interested, here is how you can find out if you have the CCR5 gene from one or both parents.

There is a company in the UScalled “32andme” that does a broad range of genetic tests, including testing for the CCR5 gene. To order the kit, and instructions on how to send a saliva sample to the company in the US, go to https://www.23andme.com/store. The test costs $209 US (so that is about 50 cents Canadian LOL). To see an example of the report you will receive, look at: https://www.23andme.com/health/Resistance-to-HIV-AIDS/ . I assume there are other places that test for HIV immunity, but I did not find them. I hope that readers will post addresses of other places to get tested for CCR5 at xtra.ca as a comment to this column.

I wonder if the reason people do not hear much about HIV immunity is that some will worry that it will perhaps give people a licence to not practice safe sex. If there is more condomless sex, then there is the chance of spread of STIs. However, it is important to remember that we are only talking about a small number of guys who will be immune to HIV. Although we should find in the gay community that older negative guys who have frequent condomless sex are much more likely to have the CCR5 gene because many of those without it protection will have become positive or will have already died.

It has been a year since my first column came out. It is time to talk what has and has not changed in that year.

Know the risks of HIV transmission got lots of attention, and some professionals in the field of HIV did not like it. I only quoted Spectrum Health’s website for the data, but people who did not like what I said about risks attacked me but not the 10 doctors at Spectrum who specialize in the field. Interesting I think.

PEP (Post Exposure Prophylaxes) seemed to stir some interest. Although BC is generally advanced in addressing HIV issues, we are backward in addressing PEP. Guys can be kept from getting HIV by going to the Hospital emergency room and getting PEP. But BC is slow to act, now that is about to change. In the next few weeks PEP will be available to guys who feel they were exposed to HIV. The wheels move slowly and every day more guys are needless infected by HIV, but finally PEP will be available soon!

What happened with the condoms? Well I was told by the media person at BCCDC that a committee decides on which condoms will be bought, I was told that I would not be told who is on that committee and I would not be told what goes into making a decision. But now there are new condoms provided for the public. I manufacture of these condoms claims that they exceed the US and International standards for condoms. The only criticism I have seen about the new condoms it that they may be a bit small. Now the HIM clinic at 1033 Davie gives out larger condoms and non-latex condoms.

Where is the wart vaccine? I am told that the BC Cancer XXX will be recommending that the wart vaccine become available for males. I talked to a doctor in the field and he said that if he were again out on the sex market he would get the vaccine because it has few side effects and help a person immune system cope with the wart virus. A very nice nurse took the time to review my article and point out places in my article that were unclear and could have presented the issue more accurately.

Loneliness feeling disconnected. Well this one seemed to get the most positive reaction for people. It seems though that most people could identify with the problem. But most people in the helping business seemed to miss my point that though there are many activities for gay guys to participate in, there are reasons they don’t. People are less likely to attend group discussion than a course where because of shyness (or whatever). I called for courses to help guys address their isolation but people seemed to respond with the same programs that are out there.

I expected a lot of reaction to HIV immunity but it seemed like interesting information at people took in to use as they might.

How often should you get tested? Well BCCDC is working on a policy about how often gay guys should get tested. I think that risk based testing as well as routine testing is the best answer. IF you have a risk then get tested, if you tend to be a bottom who has lots of sex then your routine might be every 2-3 months, if you tend to be a top than every 3-4 months get tested. We will see what BCCDC has to say eventually.

Now for some personal reflections about this column. Not everyone likes what I say here. I was surprised how intensely some people will react to me voicing my opinion. I think I am a bit naive about this, but I did not expect some of the reactions I got. Someone lobbied Xtra to have me fired, I felt bullied by someone. Some professionals started talking about me being mentally ill in an apparent attempt to discredit me. One person hit me, though it was not an assault it was harder than necessary just to make a point. And there were many guys who will come up to me and tell me how much they enjoy what I write about. I hope it is useful and gets discussion going about important topics for our health. My goal is to create a healthier and happier community for us all.

There are many things that gay guys may do to excess. The excess causing the most problems I see in our community are: alcohol, Crystal Meth, coke, body image concerns. The things that we do not do enough of are: self love, support for each other, self acceptance as we are, pursuing things that make us really happy. Here I will look at the excesses.

Is there anything wrong with occasionally using drugs? While some gay guys do not use substances there are many who do. A few of those who use substances sometimes have trouble because of their use.

Some of the main problems around substance use are: unsafe behaviour, using drugs so much that is causes problems for the user i.e., financial concerns, and disrupting relationships, hindering personal growth.

I have tried to experience most drugs during my life, but I have not achieved that yet.

I think that the typical way of approaching problem substance use is to focus on the drug and not on the reasons for using the drug(s). There are reasons why we may use drugs. Drugs do something for the user. The most common benefit we look for in substance use is to feel free/uninhibited. Crystal Meth is a good example of this. Crystal Meth often allows guys feel sexually free; to be free to be the sex pig they would like to be but are too inhibited to freely enjoy such sex without the assistance of drugs. Alcohol also helps guys to feel less inhibited; coke can help guys to feel less vulnerable/more in control. Marijuana can help us to feel more mellow/relaxed.

So the common theme behind most of this substance use is to compensate for feeling inhibited. We do not feel free enough to be ourselves. We learned at an early age to not be the gay kid in school, to not be who we are, to hide who we are … to inhibit our natural feelings. It is no surprise to see our community use drugs that helps us to feel less inhibited and freer to be ourselves.

Most of us spent years trying to survive childhood and early adulthood by hiding our feelings, because we felt that was the only way to survive and thrive. We knew that there was a risk in being free to be ourselves, these risks are real and intense, the most common fears of being ourselves centred around: safety risks (gay bashing), risk to our career advancement, risks to being teased or bullied in school, risk of losing love of our family/friends. This early trauma of threat and survival will have an effect all our lives. Some of us can use these experiences to make us stronger, confident that we can handle what comes our way. For others we feel afraid, scared to be; apprehensive about the world that seems unsafe and unfair. For most of us it is a bit of both. (For me I think part of the reason for getting a PhD is to prove I was ok I was acceptable.)

It is not surprising that some of us use substances. I believe that drugs are not the problem. Drug use is the symptom. Usually the symptom is our trying to cope with fears and inhibitions in our lives.

Some guys find the traditional drug abstinence programs work for them, but many do not.

So what is another way to approach drug use in our community? There is no one answer for everyone but I believe that for most guys it is important to explore what we get out of our drug use. How can we get that same result without problematic substance use? An example of this might be, how do we be free enough to be the sex pig we enjoy being without Crystal Meth? Again in this case Crystal Meth may not be the problem but the enabler to allow us to be free. Crystal often provides the sense of being free/spontaneous/inhibited, but most guys find the actual sexual stimulation/organism is less important than the feeling of being free to be a sex pig.

We all use substances to help us feel better it may be coffee, alcohol, chocolate, etc. Do these substances we use bring us closer to being the person we feel good about, and do they make us a happier better person? If these substances do not contribute to our ultimate happiness then we may want to make some changes. We must understand our fears and inhibitions as well as work on ways to change our habits. I think drug use is not a bad thing but if we feel it is not helping us to be the best we can be, then we may want to make some changes. Some things that we can do is use less of the drug, try a different drug that does not cause us problems. But addressing the underlying issues is important to grow to be who we want to be. This may involve counselling, or self-examination, or just pushing ourselves to take some risks to be more our ultimate ourselves.